Prospective study of routine perioperative transesophageal echocardiography for elective valve replacement: Clinical impact and cost-saving implications

Transesophageal echocardiography (TEE) is widely used during heart valve re placement operations, but its clinical impact and cost-saving profile have not been studied prospectively for this indication. We investigated the cli nical benefits and cost-savings of routine TEE for elective valve replaceme nt at a regional tertiary center. We prospectively studied 300 patients (14 0 men; mean age [+/- SD], 66 +/- 9 years) undergoing aortic valve, mitral v alve, or double-valve replacements. Transesophageal echocardiography with a biplane (in 161 patients) or a multiplane probe was performed before and a fter surgery. We assessed whether the TEE findings changed die operation or the postoperative treatment and the cost of TEE either as an extension of a preexisting service or as a new-development. In 2 patients undergoing aor tic valve replacement, significant mitral regurgitation on TEE led to addit ional mitral valve replacement, and in 1 patient undergoing mitral valve re placement, aortic regurgitation also required aortic valve replacement. Imm ediate reoperation (dehisced mitral valve prosthesis) and delayed extubatio n (suspected obstruction of an aortic valve prosthesis) were prompted by po stoperative TEE. Extending an existing TEE service to routine intraoperativ e use saved up to $109 (US) per patient per year. Routine intraoperative TE E can provide major clinical benefit to a small proportion of patients unde rgoing elective valve replacement, and this can lead to cost savings, but o nly if the service can be provided without major capital investment.